Abstract Staphylococcus warneri is the Gram-positive coagulase-negative Staphylococcus . Spondylodiscitis caused by S. warneri is rare. Only a few cases have been reported in the literature. The presentation of spondylodiscitis by S. warneri is atypical. Usually, the patients present with chronic back pain mechanical in nature. Our case is a middle-aged man with a chronic dull aching back that improves well after surgery and antibiotic therapy.

Sciatica is most of the time due to lumbar disc herniation. Some other pathologies such as aneurysmal bone cysts, proximal femur osteomyelitis, arachnoid cysts, facetal cysts, giant cell tumours, and pyriformis syndrome mimic sciatica are termed sciatica mimickers in literature. In this case report, we present a 66-year-old man with low back pain and left sciatica and neurogenic claudication who underwent transforaminal lumbar interbody fusion L4–5. In magnetic resonance imaging, the finding was degenerative changes with foraminal stenosis of L4–L5, but intraoperatively, we found an engorged epidural vein causing the compression of L4 exiting nerve root. The engorged epidural vein sometimes can cause sciatica which mimics the disc herniation.

Abstract Background: Back pain or neck pain is the most common complaint patients present to our outpatient department. It may be associated with or without radiating pain and neurological deficits. The spinal intradural tumors causing pain with or without radiating symptoms are not uncommon in our spine practice. It may be extramedullary or intramedullary. It is readily diagnosed by clinical examinations and radiological investigations. Most of the time, the treatment option is surgery which is decompression and excision of the tumor with or without instrumentation. Materials and Methods: It was a retrospective study done between 2018 and 2023. All the patients were followed for 1 year. It includes the cervical, thoracic, lumbar, and sacral regions. All patients had a posterior approach, surgery done by a single surgeon. The tumor material was sent for histopathological examinations. The follow-up was done neurologically by the Frankel scoring system at 3 months, 6 months, and at the end of 1 year and radiologically by magnetic resonance imaging at the end of 1 year. Results and Discussion: Most of the patients had schwannoma on histopathological examination. All patients had excellent postoperative outcomes. One patient had a dural leak complication treated by dural repair. None of the patients had recurrence. The spinal intradural tumor has a good prognosis due to its benign nature. The selection of the patients at the right time during disease and planning of surgery which is complete surgical excision carries a good prognosis.

Sciatica is the pain that radiates from the lower back or buttock to the posterior thigh, calf, and towards the foot. The most common cause of sciatica is intervertebral disc prolapse or degenerative spinal conditions. A few rare conditions also cause sciatica-like symptoms, termed sciatica mimicker. A case report of a 26-year-old male with back pain and radiating pain to both lower limbs. On examination, he had a positive straight leg raising test (SLR). On Magnetic resonance imaging, he had an intradural extramedullary tumor (IDEM) at the L1 level. He underwent posterior decompression and surgical resection of the tumor. Histopathological examination (HPE) consistent with Schwannoma. Lumbar schwannoma is a benign slow-growing intradural extramedullary tumor presented as a sciatica mimicker. After surgery, the patient becomes symptomatically better.

Abstract Unstable sacral fractures are mostly associated with spinopelvic instability. This type of fracture occurs following a fall from height or a high-energy mechanism. Roy–Camille’s classification system helps in identifying and treating those fractures. Lumbopelvic fixation or spinopelvic fixation is an option to be considered for treating these unstable fractures. The principle of treating these fractures is to maintain the sacropelvic stability. A 54-year-old male patient presented with a history of falling from a tree from a height of 9–11 feet on his back. On further examination, he was having severe tenderness over the sacral region and dorsal spine region. His power was normal on both lower limbs, with numbness over the base of the scrotum with intact sensation distally. Deep tendon reflexes and plantar reflexes were normal. Radiographs show fracture over D12 (AO A5 – stable incomplete burst fracture) and the sacrum. Computerized tomography and magnetic resonance imaging were taken to decode the sacral fracture and to assess the neurology and posterior ligament integrity. His sacral fracture was classified by Roy–Camille type 3, U-shaped fracture, and Denis type 2 fracture.

Osteochondroma is commonly found in the appendicular skeleton, though, relatively rarely, they occur in the spine, especially in the thoracic pedicle. A thorough radiographic workup is mandatory for a diagnosis. This is a case of a 13-year-old boy who developed gradual weakness over the lower limbs for the past 6 months, which worsened rapidly to 2/5 motor power over the last 3 weeks. A multidetector computed tomography suggested the diagnosis of a solitary osteochondroma of the D6 pedicle. Laminectomy and costotransversectomy with partial facetectomy and complete excision of the tumor with posterior instrumentation were done. Histopathological biopsy confirmed the tumor to be an osteochondroma. The power of the lower limbs improved postoperatively with physiotherapy to 3/5 at 6 weeks, 4/5 at 3-month follow-up, and 5/5 at 6-month follow-up. At 6-year follow-up, the patient is doing absolutely fine without any residual weakness or neurological deficit. Osteochondroma of the spine is rare. However, if they do occur, they usually need to be thoroughly investigated for accurate diagnosis and precise surgical treatment. These tumors could be presented with just a back pain or with progressing neurological deficits. A high index of suspicion and wide options of evaluation and management could change the course of the disease and the functional outcome of the patient.

Introduction: Spinal hemangioma is the most common benign lesion of the spine with an incidence of 10–12%. Aggressive hemangioma presents with back pain, deformity, or neurologic deficit. Aggressive hemangioma presenting as painful scoliosis is very rare and literature reporting them is very limited. Case Report: We present the case of a boy in his second decade who presented with back pain for 1 month radiating to his right chest with a deformity in his back. MRI showed a hyperintense lesion involving the sixth dorsal vertebra in the T2-weighted image and a hypointense lesion with striations in STIR images suggestive of hemangioma. Pre-operative embolization was done using micro platinum coils. The patient underwent a decompressive laminectomy and vertebral body decompression. The patient also underwent 12 cycles of radiotherapy. The patient had complete resolution of the deformity without any recurrence at 2 years. Conclusion: Management of aggressive hemangiomas with neurologic deficit needs a multidisciplinary approach with surgery, pre-operative embolization, and post-operative radiotherapy.

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Goldenhar syndrome is a condition comprising various congenital anomalies of structures developing from the first and second branchial arches. Classically, it includes impaired development of structures such as eyes, ears, lips, tongue, palate, mandible, maxilla, and vertebral anomalies. The etiology for this syndrome is not clear; however, genetic and many other causes have been described for the development of the abovementioned anomalies. A 13-year-old boy presented with deformity of the back since birth, which is gradually progressing, now causing difficulty in breathing on exertion. Parents give a history of anomalies of the eyes, ear, face, and deformities of the neck and chest since birth. X-ray, computed tomography, and magnetic resonance imaging of the spine showed severe congenital scoliosis with multiple vertebral and rib anomalies with no intraspinal anomalies or spinal cord malformations. Posterior scoliosis correction and fusion with convex side costoplasty were performed after a detailed preoperative workup in view of syndromic etiology. Postoperatively, the boy was stable and the check X-ray showed satisfactory deformity correction. Severe scoliosis with Goldenhar syndrome always throws a challenge to treating spine surgeons as they are associated with multiple other regional and systemic abnormalities. A detailed examination, preoperative clinical and radiological workup, and proper planning are very much essential in treating these deformities.

Background: Back pain in the pediatric population is a common complaint with wide differentials including mechanical cause, musculoskeletal involvement, infectious or inflammatory pathologies, and tumors. Transient back pain is common among children, and in majority of cases resolves without any treatment or with rest and mere hot/cold fomentations. However, pain disproportionate to physical findings and not reduced by pain medications, strongly suggest the presence of a serious underlying pathology. Case presentation: A 13 year old boy presented with a history of mild mid back pain lasting for a week associated with gradually developing deformity of the back, noticed by his parents. There is no history of any injury or fall prior to presentation. He had no history of any other constitutional symptoms. Upon radiological investigations he was found to have an isolated lytic lesion in D9 vertebra with differentials of tubercular/neoplastic/metastatic etiologies. Histopathological examination after biopsy was suggestive of Langerhans cell histiocytosis and was proven by immunohistochemistry. He was managed with conservative line of treatment with analgesics and other supportive care. Discussion: LCH is considered a pediatric disease, and involvement of the pediatric spine in not uncommon. A child presenting with persistent and progressive back pain should be evaluated in detail even if the child is not presenting with any other constitutional symptoms to rule out rare causes of vertebral lytic lesions. There are no cases reported in the literature suggesting LCH of the spine in pediatric population presenting as the deformity of the back. Conservative treatment is a good choice for a patient with LCH without neurological deficits or spinal instability. Keywords: Spine deformity, Children, LCH, Back pain

Vertebral metastasis as initial presentation for follicular thyroid carcinomas is rare and requires proactive management to minimize disability considering a good associated long-term survival. A review of literature in 2019 noted 27 such cases – most of the patients had solitary vertebral metastases or multiple adjacent level involvement. Surgical treatment in such cases is usually based on the extent of fractures or neural compression in the form of decompression, debulking, or total en bloc resection and biopsy. Pedicle screw placement has been studied in several large studies, and clinically relevant misplacement is rare and revision may be required. We present a case where a patient with a pathological fracture previously evaluated and operated came to us with radiculopathy caused by metastatic mass lesion and a misplaced pedicle screw.

Osteoid osteoma is a small, benign, painful tumor. Its size is the main distinguishing feature between osteoid osteoma and osteoblastoma and varies between 1.5 and 2 cm. Computed tomography (CT) is usually the best technique for imaging osteoid osteoma because the tomographic nature of the images makes it easy to visualize a lucent nidus, among the surrounding dense bone sclerosis. Vascular supply of osteoid osteoma tumor and nidus are well described. A new CT finding that is vascular groove sign is highly sensitive and specific for osteoid osteoma. It was found that most of this sign was seen in the long bones with very few in the flat bones and only one case of vascular groove sign in the body of the vertebra. A 15-year-old girl presented to us with complaints of lower back pain of 15 months; Pain was a dull-aching type which subsides by nonsteroidal anti-inflammatory drugs and reappears in the middle of the night. She was evaluated and diagnosed to have osteoid osteoma on CT scan with typical vascular groove sign in the vertebral body of L5, which is not mentioned in the literature to the best of our knowledge. Vascular groove sign is highly sensitive and specific for the diagnosis of osteoid osteoma by CT scan; this sign is mentioned mostly in the long bones with only one case in the lamina of the vertebra. We report a case with vascular grove sign in osteoid osteoma of the vertebral body of L5.

Central diabetes insipidus, though uncommon in children, has varied causes, the commonest ones being genetic mutations, infiltrative disorders, infections. Isolated central diabetes insipidus is not one of the often encountered conditions in the pediatric practice. Here we report a case of 2 ½ years old female child who presented to us following history of polyuria for 2 months, who was confirmed to have central diabetes insipidus which was later evaluated to be secondary to Langerhans cell histiocytosis. Magnetic resonance imaging (MRI) and histopathological studies further helped in confirmation of the diagnosis. Langerhans cell histiocytosis is a rare, multifarious, and underdiagnosed hematologic disease in which isolated diabetes insipidus can be the sole presenting feature before other manifestations. Hence, this diagnosis could strongly be considered in the work up of central diabetes insipidus in children.

Background: According to the World Health statistics, in 2016 more than 100000 deaths were caused due to unintentional poisonings. Children are vulnerable due to their smaller body surface area, an inherent behaviour of negation, curiosity in exploring their surroundings, their initial phallic stage where they tend to put any objects they come across into their mouth.Methods: This study is a hospital based retrospective observational study where the records of all the children admitted due to poisoning, accidental or intentional from June 2012 to November 2018 were reviewed. All the children admitted due to food poisoning and idiosyncratic drug reactions were excluded from the study.Results: A total of 203 cases of accidental ingestion were admitted during the study period, of which the majority of the patients were male children. The age group varied from 5 months to 14 years. Majority of the accidental ingestions were due to kerosene (108), followed by insecticides (25) and cleaning agents (20).Conclusions: Poisoning in young children is unintentional and accidental; hence the introduction of safe child resistant containers should be encouraged in storing harmful chemicals. Knowledge about the chemicals, awareness about their hazardous effects and education of the care givers about safe storage would be the first step in the prevention of accidental ingestion. Establishment of a reporting system from all the health care centres and establishment of poison information system at all the levels is the need of the hour.

Aim: The present study is a prospective analysis of neuromonitoring [somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (TcMEP)] in consecutive scoliosis surgeries done at a tertiary care spine centre.Materials and Methods: Prospective analysis was performed on 52 consecutive patients undergoing scoliosis correction from 2013 to 2015. SSEPs were obtained by stimulating the median and tibial nerves with stimulus intensity level 20-25 mA. TcMEPs were recorded bilaterally from abductor pollicis brevis, biceps, and deltoid for the upper limb, and from tibialis anterior, quadriceps, gastrocnemius, and abductor hallucis for the lower limb. Stimulation was given in the form of a high voltage (300-400 V) stimulus. An "alert" was defined as reduction in the amplitude of at least 50% for SSEP and at least 65% for TcMEP compared to the baseline recordings and an increase in the latency by more than 10%.Results: The mean age of the patients was 14.6 years (7-33 years). Thirty-nine of the patients were females and 13 were males. Baseline values in neuromuscular scoliosis were low compared to adolescent idiopathic scoliosis (AIS). There were no false negative incidents. False positive cases were due to low blood pressure and malfunctioning of the leads.Conclusion: Use of upper limb leads could help in identifying malposition or malfunctioning of leads to eliminate false positive results. Combined multimodal intraoperative monitoring helps in increasing the safety in scoliosis corrective surgeries with a high sensitivity and specificity. Baseline values in neuromuscular scoliosis patients are possibly lower than idiopathic scoliosis patients. Intraoperative variations must be interpreted with caution.

High grade chondrosarcomas traditionally were treated with resection arthrodesis or amputation of the extremity, with unfavorable functional outcomes. Improved imaging and surgical techniques has stimulated the search for a more functional surgical approach. The current trend is for resection and reconstruction to save the limb whenever possible. Since most patients with primary bone sarcoma are young and active, treatment by amputation has poor psychological acceptance. Reconstruction of the defects is the major challenge in the management of bone sarcomas. The options now available are custom made prosthesis and bone grafts. Few studies were done with autologous grafts or custom made prosthesis alone. The combined use of all the modalities enabled us to fill the defect and augment the fixation effectively. We put forward a case report of chondrosarcoma reconstructed after an extensive resection using non vascularised fibula, corticocancellous grafts from ASIS and a custom made prosthesis.

Aims: To analyse the intra operative findings, outcome and complications of Microdiscectomy in recurrent lumber disc herniations without instability.  Settings and Design: A retrospective study. Methods and Material: Recurrent lumbar disc herniation was defined as disc herniation at the same level, regardless of ipsilateral or contralateral herniation, with a pain-free interval of more than 6 months. Eight patients who had undergone microdiscetomy for recurrent lumbar disc herniation were evaluated retrospectively. VAS scoring system was used to score the pain. Dynamic radiographs were obtained to rule out the instability at lumbar spine. Contrast MRI was performed in all patients. Microdisectomy was performed using operative microscope. The degree of herniation, pain free interval from index surgery, intra operative findings, clinical improvements and complications were recorded. Results: There were seven cases of ipsilateral herniation and one case of contralateral herniation. The mean pain free interval was 46.8 months (range: 7–120) from index surgery. The level of recurrent disc prolapse was more common at L5-S1 (five) followed by L4–L5 (three). The degree of herniations included protrusion in two cases, extrusion in 4 cases, sequestration in two cases and some degree of root adhesion was seen in all cases. The complications included re-recurrence at 1 month, superficial surgical site infection and re-exploration for persistence of symptoms. Mean follow up was 19.3 months (range: 12–48 months).The VAS score for leg pain significantly improved at one year follow up (P u003c 0:05). Conclusions: Microdiscectomy is a good treatment option in recurrent lumbar disc herniation without instability.

Objectives: To report on unique cases of spinal compression fractures due to pregnancy-associated osteoporosis (PAO) and to suggest a satisfactory treatment modality.Materials and Methods: A single-center retrospective study. We reviewed the data of 535 patients with osteoporotic spinal compression fractures over a period of 5-year. Two patients who developed spinal compression fractures due to PAO were identified and treated.Results: The clinical presentation and blood investigations ruled out other causes of osteoporosis. Dual-energy X-ray absorptiometry was used to confirm the diagnosis. All patients improved with medical management.Conclusion: Vertebral fractures due to PAO should be considered as a differential diagnosis in patients with back pain who are in the third trimester of pregnancy or in postpartum. Early recognition and appropriate conservative management would be necessary to prevent complications such as new vertebral fractures and chronic back pain.

Giant Cell Tumour of Bone (GCTB) is a benign but locally aggressive osteolytic skeletal neoplasm of young adults consisting of giant cells expressing RANK (Receptor Activator of Nuclear Factor-κB) and mesenchymal spindle-like stromal cells expressing RANKL (RANK ligand). The interaction of these cells leads to bone resorption. Recently, the RANKL inhibitor, denosumab, has demonstrated activity against giant-cell tumours. The current article reports a case of a Giant cell tumour of left distal femur with pathological fracture. A 34-year-old male patient presented with history of on and off dull aching pain in the left knee for 4 months followed by a history of trivial fall. He sustained a closed injury in the left knee, following which he was unable to bear weight and developed pain and swelling in left knee. Conventional radiographs and Computerized tomography (CT) was done which showed the presence of a left distal femoral osteolytic lesion and a histological analysis of a biopsy specimen confirmed the diagnosis of GCTB. The patient was treated with neoadjuvant denosumab therapy which resulted in successful downstaging of the tumour followed by extended curettage of the lesion with high speed burr and argon laser cautery. The post-curettage microscopic examination revealed the absence of osteoclast-type giant cells.